Appendix B: Dr. Yoho as Your Surgeon

On The Day of Your Procedure

We start early, so some of you will come in at 6 AM. You will sign some more papers giving us permission to do your case, and you will take a few mild pills to give you some 24 hour pain relief and relax you before your procedure. After these have had a chance to take effect, you will be helped into our procedure room, cleaned from head to foot with special soap, and then after you lie down, we use local anesthetic to put an IV in your arm. You will be attached to blood pressure, heart, and oxygen monitors. Most patients will then be given more relaxation medicine in a slow drip (the ones who want pure local technique won't). Next, we put the local anesthetic in your fat. This is painless for the vast majority of people. You may require several quarts if you're having liposuction. It's mainly salt water with a little bit of numbing medicine and adrenaline. Then we perform the liposuction with our small cannulas, or start the other procedure, whatever it is. If you are having pure local anesthetic, you will be able to speak to us during the whole procedure, but if you are getting some IV sedation, you will be more sleepy. Most people leave the office within a half-hour to two hours after the procedure-although sometimes for transportation reasons they may stay a little longer. When you are ready to go, we will drive you to the convalescent hospital if you are staying there, or your family will pick you up and take you home.

Anesthesia and Pain Relief

Although we offer pure local " tumescent " anesthetic, we believe the best anesthetic for cosmetic surgery is local plus intravenous sedation. There is a lot of marketing going on saying that either:

• Pure local anesthetic technique is safer or better
• General anesthetic is better

NEITHER IS TRUE!

Both the pure local and general anesthetics have their problems. At least one doctor (Klein) believes that general anesthetic and liposuction is a dangerous combination (click here to read a scientific article). Although I don't necessarily believe that this is the whole truth, (and to the best of my knowledge, Klein has no experience with general anesthesia techniques) I think that patients should be well educated about the controversy.

Local anesthetic, on the other hand, is certainly safe, but a lot of patients have significant pain or anxiety. I think they usually do better with the artful and conservative use of intravenous sedation. We can make you more or less sleepy at your request. A lot of people don't even remember the procedure. But we never use gas inhalation general anesthesia with a machine, and we don't put a tube in your throat to breathe. Because of our lighter medications, your chance of nausea or a hangover is minimal. We generally have at least three licensed people plus one aide in your room watching you at all times. And again, we are happy to use "pure local anesthetic" if you request-we've performed this technique for over l000 patients.

What About Pain After the Procedure?

It's different for everyone, but most people say that the experience is very tolerable. Ninety per cent of our patients need no pain medicines but Tylenol® a day or two after the procedure. But some people complain, and we use stronger pain medications for them. Pain is such an individual thing. You must remember that your result may be a trade-off between your recovery and the perfection of your figure. That is, sometimes if we spend a little extra time working on your fat, you may be a bit more sore in exchange for that nice result. Most people are doing pretty well at a week or two, but if you are having trouble, we have some recovery techniques you should use (click here to learn about special machines Dr.Yoho uses for his patients' recovery).